Postoperative Esophageal Cancer Patients Research Articles

Efficacy and safety evaluation of mixed nutrition for postoperative esophageal cancer patients in China: a meta-analysis.

The purpose of this study was to evaluate the clinical effect of mixed nutrition and parenteral nutrition support on postoperative patients with esophageal cancer. By searching PubMed, Web of Science, Cochrane, CNKI, Wanfang and other databases, all the literatures until March 2024 about the comparison of randomized controlled Trial (RCT) of mixed nutrition and parenteral nutrition support in postoperative patients with esophageal cancer were screened. The inclusion criteria were that the patients were from randomized controlled trials or clinical trials in China, and the patients were all diagnosed with esophageal cancer by pathological biopsy. The exclusion criteria were the literature other than the above, including repeated published literature, non-Chinese and English literature, incomplete or missing analysis data, etc. After two researchers independently screened the literature, extracted the data and evaluated the risk of bias according to the criteria, Meta-analysis was carried out with RevMan 5.4 software. A total of 11 studies were included, including 1216 patients. Meta-analysis showed that, compared with parenteral nutrition, mixed nutrition can improve the levels of transferrin, serum albumin, prealbumin and lymphocyte counts in patients with esophageal cancer after surgery, shorten the time of anal recovery of exhaust, defecation and hospital stay after surgery, and reduce the incidence of pulmonary infection, abdominal distension, incision infection and anastomotic fistula, with statistical significance between the two groups (P < 0.05). The heterogeneity of individual results in this study is relatively high, the analysis comes from clinical heterogeneity, and the publication bias is analyzed through Funnel plot. Taking the incidence of lung infection as an example, the results are evenly distributed on both sides of the Funnel plot, and the publication bias has little impact on the results of the study. Compared with parenteral nutrition, mixed nutrition can improve the prognosis of postoperative patients with esophageal cancer and reduce the incidence of related adverse events.

Prognostic value of systemic inflammation score in patients with esophageal cancer.

The systemic inflammatory score (SIS), a new inflammatory marker based on a combination of the lymphocyte-to-monocyte ratio (LMR) and serum albumin concentration, has been reported to be a useful prognostic marker for several malignancies. The authors conducted this retrospective study on data from a cohort of esophageal cancer patients undergoing potentially curative resection to clarify the value of SIS as a prognostic marker for clinical outcome in this population. This retrospective cohort study included 32 patients who underwent thoracoscopic esophagectomy after neoadjuvant chemotherapy for esophageal cancer between January 2016 and December 2019. Blood samples were collected within one week prior to the initiation of preoperative chemotherapy. Three inflammatory and nutritional markers; SIS, the neutrophil-to-lymphocyte ratio (NLR), and prognostic nutrition index (PNI) were examined in this study. Disease-free survival was assessed using the Kaplan-Meier method, and univariable and multivariable Cox models were applied to evaluate the predictive value of SIS, NLR and PNI. NLR and PNI were not associated with recurrence, while SIS scores of 1 and 2 were significantly associated with recurrence. In multivariate analysis, SIS scores of 1 or 2 were found to be independently associated with recurrence, each with a hazard ratio of 1.98. In addition, when examining immunologic and nutritional factors and survival rates, there was no significant difference in the survival rate for NLR and PNI; for SIS, however, the survival rate was significantly worse in patients with SIS scores of 1 or 2. The authors demonstrated that a novel and easily obtained prognostic score, termed SIS, based on pre-treatment serum albumin and LMR, can serve as an independent prognostic factor in postoperative esophageal cancer patients. It could be incorporated into conventional clinical and pathological algorithms to enhance the prognostic accuracy in this population.

Five-Year Prognosis Model of Esophageal Cancer Based on Genetic Algorithm Improved Deep Neural Network

ObjectivesEsophageal cancer is a high occult malignant tumor. Even with good diagnosis and treatment, the 5-year survival rate of esophageal cancer patients is still less than 30%. Considering the influence of clinical characteristics on postoperative esophageal cancer patients, the construction of a neural network model will help improve the poor prognosis of patients in the five years. Material and methodsIn this study, genetic algorithm optimized deep neural network is exploited to the clinical dataset of esophageal cancer. The independent prognostic factors are screened by Relief algorithm and Cox proportional risk regression. FTD prognostic staging system is established to assess the risk level of esophageal cancer patients. ResultsFTD staging system and independent prognostic factors are integrated into the genetic algorithm optimized deep neural network. The Area Under Curve (AUC) of FTD staging system is 0.802. FTD staging system is verified by the Kaplan-Meier survival curve, and the median survival time is divided for different risk grades. The FTD staging system is superior to the TNM stages in the prognosis effect. The AUC of deep neural network optimized by genetic algorithm is 0.91. ConclusionThe deep neural network optimized by genetic algorithm has good performance in predicting the 5-year survival status of esophageal cancer patients. The FTD staging system has a significant prognostic effect. The FTD staging system and genetic algorithm optimized deep neural network can be successfully availed in clinical diagnosis and treatment.

Preoperative evaluation of oral hygiene may predict the overall survival of patients with esophageal cancer.

Previously, the association between tooth loss and prognosis after esophagectomy was reported; however, the presence of periodontal disease has not been assessed. This study investigated the association between the degree of oral hygiene, as evaluated by tooth loss and periodontal disease, and the prognosis of patients with esophageal cancer. A total of 163 esophageal cancer patients who underwent surgery with perioperative oral care and examination were enrolled. We assessed the periodontal pocket depth for the presence of periodontal disease and established a periodontal pocket index, defined as the sum of the periodontal pocket depth of the remaining tooth divided by the total count of the remaining teeth. Patients were divided into three groups: Group A (tooth loss < 13 and periodontal pocket index < 3.67); Group B (tooth loss < 13 and periodontal pocket index ≥ 3.67); and Group C (tooth loss ≥ 13). Overall survival and cancer-specific survival were analyzed, and a multivariate analysis was performed. There was a significant difference in the 5-year overall survival rates between the groups (A:B:C = 74.8%:62.8%:50.5%; p = 0.0098), but not in the 5-year cancer-specific survival rates (A:B:C = 80.2%:64.2%:62.2%; p = 0.0849). In multivariate analysis, oral hygiene (tooth loss < 13 and periodontal pocket index ≥ 3.67 + tooth loss ≥ 13; p = 0.041) was a significant independent poor prognostic factor for overall survival. Oral evaluation, focusing on tooth loss and periodontal disease, is meaningful in predicting the long-term prognosis of postoperative esophageal cancer patients.

Eating Behaviors of Postoperative Esophageal Cancer Patients During the First Year After Surgery.

The objective of this study was to identify the eating behaviors of patients from 3 months onwards after esophageal surgery. The study was conducted on patients who had been on an oral diet for more than 3 months after the surgery. Data were collected through interviews and analyzed by a qualitative inductive method based on the Grounded Theory Approach. The results of the analysis revealed that postoperative esophageal cancer patients go through the following three stages in respect of their eating behavior during the first year after surgery: i) Get used to swallowing, ii) Learning how to cope with the symptoms occurring during eating, by failing and succeeding repeatedly, and iii) building self-management skills in terms of eating behaviors. These were identified as the process through which the patients develop their eating behaviors during the first year after surgery. The patients first faced the reality of the underlying issue, namely, difficulty in eating after the surgery, with the feeling that they experienced during swallowing in the process of eating. However, they had no choice but to accept the reality and make efforts to devise practical eating behaviors through experience. Then, eventually, they learned that self-management is necessary not only for maintaining a stable eating behavior, but also for sustaining their lives. In the long-term post-operative patient's acquisition of new eating habits, medical staff look back and share their experiences so that they can recognize their altered body without being discouraged. However, it is necessary to continue to support them even after they discharge from the hospital by accepting difficulties in eating behavior.

Physical Activity Among Postoperative Esophageal Cancer Patients.

Previous literature has reported that regular physical activity enhances health-related quality of life for cancer patients. However, there is a lack of studies that focus on physical activity among postoperative esophageal cancer patients. The aims of this study were to (1) describe the prevalence of physical activity among postoperative esophageal cancer patients, (2) explore variables related to physical activity (demographics, nutrition, dysphagia, and health-related qualify of life), and (3) examine potential reasons for inactivity among participants who scored low using case studies. In this cross-sectional design, physical activity was evaluated by the Japanese version of the International Physical Activity Questionnaire. Variables were analyzed using Spearman rank correlation coefficients, Mann-Whitney U tests, or Fisher exact tests. Fifty-eight patients participated in this study; 79% met the recommended physical activity guidelines. Present occupational status and past leisure-time physical activity behavior before the cancer diagnosis were related to current leisure-time physical activity and meeting the guidelines postoperatively. Participants who scored 0 (little or no activity) in the questionnaire also scored low in health-related quality of life. Participants performed especially well in physical activity related to leisure time and transportation. Positive reinforcement is needed for patients who perform adequate levels of physical activity, and reviewing the benefits of regular physical activity is encouraged for all. Occupational status and past leisure-time physical activity before diagnosis can be indicators for promoting physical activity among postoperative esophageal cancer patients. Inactive participants should be supported to promote both physical activity and health-related qualify of life.

Suitable Food Textures for Videofluoroscopic Studies of Swallowing in Esophageal Cancer Cases to Prevent Aspiration Pneumonia.

To determine suitable food textures for videofluoroscopic study of swallowing (VFSS), in order to predict and prevent subsequent aspiration pneumonia in esophageal cancer patients with dysphagia after surgery. We evaluated 45 hospitalized esophageal cancer patients who underwent surgery between January 2012 and December 2013. The control group consisted of 43 patients treatmed from January 2010 until December 2011 and were not examined by VFSS. Test foods, which were presented in order of increasing thickness, included thin barium sulfate (Ba) liquid (3 or 10 ml), slightly thickened Ba liquid (3 or 10 ml), a spoonful of Ba jelly, and a spoonful of Ba puree. Patients could most safely swallow puree, followed by jelly. The 3mL samples of both the thin and thick liquids put patients at risk for aspiration pneumonia, with incidence rates of 13% and 11%, respectively. While 64.4% of patients could swallow all test foods and liquids safely, 35.6% were at risk for aspiration pneumonia when swallowing liquids. Even though >30% of patients were at risk, only 1 (2.2%) in the VFSS group developed aspiration pneumonia, which occurred at the time of admission. Following VFSS, no incidence of aspiration pneumonia was observed. However, aspiration pneumonia occurred in 4 (9.3%) control patients during hospitalization. Postoperative esophageal cancer patients were more likely to aspirate any kind of liquid than solid foods, such as jellies. VFSS is very useful in determining suitable food textures for postoperative esophageal cancer patients.

Modified Dachengqi Tang improves decreased gastrointestinal motility in postoperative esophageal cancer patients

ObjectiveTo investigate the clinical effects of modified Dachengqi Tang (DCQT) on promoting gastrointestinal motility in post-operative esophageal cancer patients. MethodsSixty postoperative esophageal cancer patients were enrolled and randomly assigned to the modified treatment group or the control group (30 patients in each group). Patients in the treatment group were given DCQT made from decocted herbs and administered via nasojejunal tube at a dosage of 150 mL. Gastrointestinal motility was assessed by recording time for recovery of bowel sounds, flatus, defecation, and the total amount of gastric drainage during the first three postoperative days. Plasma motilin (MTL) and vasoactive intestinal peptide (VIP) were measured one hour before and three days after surgery. ResultsCompared with the control group, the times to first bowel sound, flatus, and defecation were significantly shorter and there was less gastric drainage in the treatment group (P < 0.01, P < 0.01, P < 0.01, and P < 0.05, respectively). In the treatment group, postoperative plasma MTL was significantly higher (P < 0.01) and VIP was significantly lower than those in the control group (P < 0.05). There was no difference found in either MTL or VIP from before to after operation in the treatment group (P > 0.05). MTL was significantly lower and VIP was higher postoperatively in the control group, compared to before surgery (P < 0.01). ConclusionsModified DCQT effectively improved decreased gastrointestinal motility in postoperative esophageal cancer patients by increasing MTL and reducing VIP.

SU‐E‐P‐33: Critical Role of T2‐Weighted Imaging Combined with Diffusion‐Weighted Imaging of MRI in Diagnosis of Loco‐Regional Recurrent Esophageal Cancer After Radical Surgery

Purpose:We perform this study to investigate the diagnostic efficacy of T2‐weighted MRI (T2WI) and diffusion‐weighted MRI (DWI) in confirming local relapses of esophageal cancer in patients highly suspected of recurrence after eradicating surgery.Methods:Forty‐two postoperative esophageal cancer patients with clinical suspicions of cancer recurrence underwent 3.0T MRI applying axial, coronal, sagittal T2WI and axial DWI sequences. Two experienced radiologists (R1 and R2) both used two methods (T2WI, T2WI+DWI) to observe the images, and graded the patients ranging from 1 to 5 to represent severity of the disease based on visual signal intensity (patients equal to or more than grade 3 was confirmed as recurrent disease)Results:27/42patients were verified of recurrent disease by pathologic findings and/or imaging findings during follow‐up. The sensitivity, specificity and accuracy of R1 applying T2WI+DWI are 96%, 87% and 93% versus 81%, 80% and 77% on T2WI, these figures by R2 were 96%, 93% and 95% versus 89%, 93% and 90%. The receiver operating curve (ROC) analyses suggest that both of the two readers can obtain better accuracy when adding DWI to T2WI compared with T2WI alone. Kappa test between R1 and R2 indicates excellent inter‐observer agreement on T2WI+DWI.Conclusion:Standard T2WI in combination DWI can achieve better accuracy than T2WI alone in diagnosing local recurrence of esophageal cancer, and improve consistency between different readers.

Application of improved double-oxygen-pipe structure for patients after operation of esophageal carcinoma

Objective To analyze the effect of improved double-oxygen-pipe structure for postoperative esophageal cancer patients. Methods We chose 60 cases of esophageal cancer patients and randomly divided them into observation group and control group, 30 cases in each group. The observation group were treated by improved double-oxygen-pipe absorption, and the control group underwent traditional single-oxygen-pipe. The change of arterial blood oxygen partial pressure (PaO2), carbon dioxide partial pressure (PaCO2) and SpO2 were observed in the two groups of patients after the operation and compared the comfort level of the oxygen absorption. Results Two groups of patients with PaO2 and SpO2 improved to (95.04±4.63)% and (96.93±4.60)mmHg after 1 day operation, compared with (91.26±7.27)%, (90.37±2.88)mmHg in the control group with statistical differences between two groups (t=2.213, 4.371; P<0.05). There were 25 cases (83.33%) of patients in the observation group with comfort, that was significantly higher than 12 cases (40%) of patients in the control group, and the differences were statistically significant (χ2=8.992, 11.365; P<0.05). The observation group had only 1 case (3.33%) self extubation which was less than that of the control group (17 cases) occupied 56.57% (Z/χ2=8.992, 11.365; P<0.05). Conclusions Improved double-oxygen-pipe structure can improve the recovery of PaO2 and SpO2 in postoperative patients and improve the comfort and compliance of oxygen absorption. This method is worthy to popularized in clinical. Key words: Esophageal carcinoma; Oxygen absorption; Comfort

Predictive factors for acute radiation pneumonitis in postoperative intensity modulated radiation therapy and volumetric modulated arc therapy of esophageal cancer.

BackgroundRadiation pneumonitis (RP) is a common side reaction in radiotherapy for esophageal cancer. There are few reports about RP in esophageal cancer patients receiving postoperative intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). This study aims to analyze clinical or dosimetric factors associated with RP, and provides data for radiotherapy planning.MethodsWe reviewed 68 postoperative esophageal cancer patients who were treated with radiotherapy at the West China Hospital from October 2010 to November 2012 to identify any correlation between the clinical or dosimetric parameters and acute radiation pneumonitis (ARP) or severe acute radiation pneumonitis (SARP) by t-test, chi-square test, and logistic regression analysis.ResultsOf the 68 patients, 33 patients (48.5%) developed ARP, 13 of which (19.1%) developed SARP. Of these 33 patients, 8 (11.8%), 12 (17.6%), 11 (16.2%), and 2 (2.9%) patients were grade 1, 2, 3, and 4 ARP, respectively. Univariate analysis showed that lung infection during radiotherapy, use of VMAT, mean lung dose (MLD), and dosimetric parameters (e.g. V20, V30) are significantly correlated with RP. Multivariate analysis found that lung infection during radiotherapy, MLD ≥ 12 Gy, and V30 ≥ 13% are significantly correlated with an increased risk of RP.ConclusionLung infection during radiotherapy and low radiation dose volume distribution were predictive factors associated with RP and should be accounted for during radiation planning.

PP212-SUN VALIDITY OF EARLY ENTERAL NUTRITION FOR POSTOPERATIVE ESOPHAGEAL CANCER PATIENTS

Rationale: Early enteral nutrition, defined as starting enteral nutrition (EN) within 3 days after surgery, has become popular, because it has been revealed that early EN for surgical patients can decrease postoperative complication, reduce mortality. In the present study, we retrospectively examined EN received esophageal cancer patients to clarify the validity of early EN for postoperative course compared with delayed EN. Methods: A total of 103 patients who received thoracic esophagectomy for esophageal cancer at Niigata University Hospital during 1996 2010 were entered. The patients were divided into 2 groups; Group E contained the patients who received EN within postoperative day 3, and Group L contained the patients who received EN after postoperative day 3. The clinical factors such as days for first gas passage (Day-FGP), the dose of postoperative albumin-drug used (Dose-Alb), difference of serum albumin value between day 7 and pre-operation (Dalb), duration of systematic inflammatory response (SIRS), incidence of postoperative infectious complication (PIC), and use of total parenteral nutrition were compared between the groups. The statistical analysis were performed by Mann-Whitney U test and Chi square test. The statistical significance was defined as p < 0.05. Results: There was positive correlation between the days for EN start and Day-FGP and Dose-Alb. TPN use was less frequent in Group E compared with Group L (p < 0.0001). Moreover, Group L showed fewer days for first gas passage (p < 0.0001), lesser dose of postoperative albumin-drug used (p = 0.0002), and shorter duration of SIRS (p < 0.0013) compared with Group L. However, there was not significant difference on incidence of PIC between the 2 groups. Conclusion: Our results showed that early EN is safe and valid for postoperative esophageal cancer patients because it might decrease albumin-drug or TPN use, and promote early recovery of intestinal movement.

Clinical study and nursing care on early feeding enteral nutrition of postoperative esophageal cancer patients with nasointestinal tube

Objective To investigate the effect of early feeding enteral nutrition on the condition of nutrition,immunologic function and normalized nursing care of esophageal cancer patients.Methods Totals of 79 patients with esophageal cancer were randomly divided into the group of enteral nutrition (EN group,40 cases) and parenteral nutrition group (PN group,39 cases).All the subjects were treated the same conditional nutrition support and normalized nursing care after operation.Evacuating time and incidence of complication in two groups were observed and relative laboratory parameters were measured prior to surgery (preoperative) and on 3rd and 7th day after operation.Results Evacuating time of EN group was shorter than that of PN group significantly [(4.1 ± 2.2) vs (5.1 ± 2.0) days ; t =2.156,P =0.037],the serum level of prealbumin (in EN group on seven days postoperatively was improved than that in PN group [(20.97 ±6.14) vs (14.44 ± 7.43)mg/dl;t =2.533,P =0.015].The improvement of lymphocyte count in EN group was better than that of PN group [(1.67 ± 0.52) × 109 vs (1.40 ± 0.49) x 109/L],and the difference was statistically significant (t =2.243,P =0.028).The incidence of postoperative alimentary dysfunction in EN group lower than that in PN group (2.5％ vs 15.4％ ; x2 =4.059,P =0.044).Conclusions It is safety and convenience to carry early postoperative enteral nutrition support to patients with esophageal cancer after operation.The improvement of nutritional status and immunologic levels of early enteral nutrition was better than that of parenteral nutrition support. Key words: Esophygeal neoplasms; Parenteral nutrition; Nursing; Enteral nutrition

Is extended volume external beam radiation therapy covering the anastomotic site beneficial in post-esophagectomy high risk patients?

Background and purposeTo assess the impact of extended volume radiation therapy (RT) with anastomotic coverage on local control in high risk post-operative esophageal cancer patients. Patients and methodsThis is a retrospective study of high risk (T3, T4, nodes positive, with or without margin involvement) post-operative esophageal cancer patients treated at London Regional Cancer Centre from 1989 to 1999. After esophagectomy, all patients received adjuvant combined modality therapy consisting of four cycles of fluorouracil-based chemotherapy, and loco-regional RT with or without coverage of the anastomotic site. RT dose ranged from 45 to 60Gy at 1.8–2.0Gy/fraction with treatment fields tailored to the pathologic findings and location of the anastomosis. CT planning was used in all patients to design spinal cord sparing beam arrangements. First relapse rate (first incidence of an event), disease specific survival and overall survival were calculated by Chi-Square, Log-Rank, and Kaplan–Meier (K–M) methods. ResultsDuring the study period, 72 patients had underwent esophagectomy and were considered for adjuvant chemoradiation therapy. Three patients were excluded due to disease progression prior to therapy. The 69 remaining patients formed the study cohort for the present analysis. The median age of the study group was 60 years (range 35–82 years). Pathologic stage distribution (AJCC 1997 staging) was T2,3 N1 in 94% patients, 65% of the cases were adenocarcinoma and had undergone transhiatal esophagectomy (86%) with positive/close margins in 34 (49%) patients. Median follow-up was 30.5 months (range 3.4–116.3 months). Two- and 5-year actuarial overall survivals rates were 50 and 31%, respectively. First relapse rate after adjuvant therapy was 63.7% (n=44) and median time to relapse was 27.2 months. Anastomosis recurrence rates were 29% with small volume and 0% with extended volume RT (P=0.041). Local and regional relapse occurred in 74.2% of patients treated with small volume RT compared to 15.4% in patients treated with extended volume RT (P<0.001). After adjusting for resection margin status, the local control benefit of extended volume RT remained significant (P=0.003). Treatment interruptions and late gastrointestinal toxicity were not significantly increased with the use of extended volume RT. ConclusionsA significant decrease in local and regional relapse without added late toxicity was achieved with the use of extended volume RT encompassing the anastomotic site post-operatively in high risk esophageal cancer patients.

Total removal of the posterior mediastinal gastric conduit due to gastric cancer after esophagectomy.

Total removal of the gastric conduit (TRGC) due to gastric cancer after esophagectomy often results in high operative morbidity and mortality rates, especially when done in the posterior mediastinum. This is one of the reasons for the retro-sternal or subcutaneous route being preferred for gastric conduit replacement in esophageal cancer operation. Five out of 680 post-operative esophageal cancer patients underwent TRGC via thoracotomy and laparotomy due to posterior mediastinal gastric conduit cancers. In these patients, advanced gastric cancers were found at an average of 84 months (ranging 57-136 months) after esophageal cancer surgery and preoperative risk factors for TRGC were found in age, nutrition, and pulmonary function. The operative time for TRGC was long (average 670 min) but not associated with operative complications, while blood loss varied among patients, with one with the most operative blood loss dying after surgery due to pyothorax and renal failure. This case, and another early case subjected to TRGC first with thoracotomy then followed by laparotomy, showed more operative blood loss (10,895 and 3,260 ml) than the later three patients (2,370, 1,900, and 1,780 ml), who underwent laparotomy before thoracotomy with ligation of the blood supply of the gastric conduit and lysis of adhesion around gastric conduit in the lower mediastinum from the abdomen. TRGC in the posterior mediastinum would be safer if operative manipulation were started from laparotomy in order to reduce operative blood loss. J. Surg. Oncol. 2004;85:204-208.